Osteoporosis in the Women's Health Initiative: Another Treatment Gap? - 26/07/17
, Jane A. Cauley, DrPH b, Cynthia Garvan, PhD a, Karen C. Johnson, MD, MPH c, Michael J. LaMonte, PhD, MPH d, Wenjun Li, PhD e, Marian Limacher, MD a, Todd Manini, PhD a, Gloria E. Sarto, MD, PhD f, Shannon D. Sullivan, MD, PhD g, Jean Wactawski-Wende, PhD d, Rebecca J. Beyth, MD, MSc a, hAbstract |
Background |
Osteoporotic fractures are associated with high morbidity, mortality, and cost.
Methods |
We performed a post hoc analysis of the Women's Health Initiative (WHI) clinical trials data to assess osteoporosis treatment and identify participant characteristics associated with utilization of osteoporosis medication(s) after new diagnoses of osteoporosis or fracture. Information from visits prior to and immediately subsequent to the first fracture event or osteoporosis diagnosis were evaluated for medication use. A full logistic regression model was used to identify factors predictive of osteoporosis medication use after a fracture or a diagnosis of osteoporosis.
Results |
The median length of follow-up from enrollment to the last WHI clinic visit for the study cohort was 13.9 years. Among the 13,990 women who reported new diagnoses of osteoporosis or fracture between enrollment and their final WHI visit, and also had medication data available, 21.6% reported taking an osteoporosis medication other than estrogen. Higher daily calcium intake, diagnosis of osteoporosis alone or both osteoporosis and fracture (compared with diagnosis of fracture alone), Asian or Pacific Islander race/ethnicity (compared with White/Caucasian), higher income, and hormone therapy use (past or present) were associated with significantly higher likelihood of osteoporosis pharmacotherapy. Women with Black/African American race/ethnicity (compared with White/Caucasian), body mass index ≥30 (compared with body mass index of 18.5-24.9), current tobacco use (compared with past use or lifetime nonusers), and history of arthritis were less likely to use osteoporosis treatment.
Conclusion |
Despite well-established treatment guidelines in postmenopausal women with osteoporosis or history of fractures, pharmacotherapy use was suboptimal in this study. Initiation of osteoporosis treatment after fragility fracture may represent an opportunity to improve later outcomes in these high-risk women. Specific attention needs to be paid to increasing treatment among women with fragility fractures, obesity, current tobacco use, history of arthritis, or of Black race/ethnicity.
Le texte complet de cet article est disponible en PDF.Keywords : Disparity, Fracture, Osteoporosis, Treatment
Plan
| Funding: The Women's Health Initiative (WHI) program is funded by the National Heart, Lung, and Blood Institute (NHLBI), the National Institutes of Health, and the US Department of Health and Human Services through contracts HSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C. The WHI project office at the NHLBI, which was the sponsor, had a role in the design and conduct of the study and in the collection and management of the data. The sponsor did not have a role in analysis and interpretation of the data, the preparation of the manuscript, or the decision to submit the manuscript for publication. Review and approval of the manuscript was carried out by committees composed of WHI investigators and NHLBI representatives. |
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| Conflict of Interest: The authors have no potential conflicts of interest to declare with respect to this paper. |
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| Authorship: All authors had access to the data and a role in writing this manuscript. |
Vol 130 - N° 8
P. 937-948 - août 2017 Retour au numéro
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